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ROUGH EDITED COPY VOLUNTEERISM AND TRAUMATIC BRAIN INJURY NSIP NOVEMBER 10, 2005 2:00 P.M. CST CAPTIONING PROVIDED BY: CAPTION FIRST, INC. PO BOX 1924 LOMBARD, IL 60148 * * * * * This is being provided in a rough-draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings * * * * >> A very important -- we have another button that I want you to click on, and I want you guys to keep it open. It's a text chat. There is a little button here. Let me find where that is. It's right here. So if you go ahead and you click on that guy, that's going to open the text chat. If you don't have a microphone, who does not have a microphone? Please raise your hand. Anybody? Okay. We have two people without? Three. Without a microphone. If you guys have a question, plea type your question there. If you have it opened, now you can see that my name appears right there. So please type your questions right there. Can raise your hand we'll read your questions. And then we'll answer them. All righty? If you don't have any other questions, I am all set. Should be ready to go. >> ELESHEVA SOLOFF: I have you on? Can you click check if you are hearing me? Awesome! That's great. Okay. I work for the corporation for national community service training at technical assistive providers. We do training -- (inaudible) -- and you can see if you have any questions. This used to be our home page, we have a national conference coming up. But this is the e-mail to click on if you have any questions. We offer 101 and partnership. Teleconference calls which is very similar to what we're doing right now. And talk about different situations every Monday and Thursday. This director had a program at the rehabilitation commission, and here to talk about known as TPIE. She will explore the challenges -- (audio not understandable) and talk accommodation and assistive devices and technology. >> She is here to train us. And without further adieu, here she is. >> Thank you. Can we do this quick survey? I want to you find out who is on the webcast. If people could take a moment it respond to this, I would appreciate it. I want to have a sense of who is with us today. I know that some of you don't have microphone. So this will be helpful. How many of you have worked with people with traumatic brain injury before? If you could push the "yes" button. Okay. Only two people. Oh, up to 3. All right, great. Are you currently working with individuals who are in volunteer positions? It doesn't seem that way. Okay. For those of you who are hooked into the webcast now, are any of you a case manager or a voc rehab counselor? Are you members of the protection advocacy within your state? If people wouldn't mind, maybe you could either in the microphone or through the text box tell me what roles do you play as it relates to people with traumatic brain injuries and volunteer service. Disability coordinator for Virginia commission. Anybody else? Okay. Well, I'm going to -- I appreciate people letting me know who you are. I am assuming that other people may join us during the webcast. And I think that we will start with the PowerPoint. One of the things that I wanted to be sure that people know is that there are a lot of slides here. I'm going to kind of move through some of them very quickly. But the reason that I've got so many slides here is that I want to you take advantage at the end of downloading a hard copy for yourselves because the information that's in some of these slides that we may not discuss in detail may be valuable to you later on. If I talk too quickly, which I tend to do anyway, please feel free to stop me either verbally or with the text message, and I will try to slow myself down. And you will notice as I go through my slides that I am going to asking if people have other examples of some of the challenges that people with brain injury may face in a volunteer capacity. Please feel free to pipe in as well. Although it sounds like only a couple of you have actually worked with people brain injuries. So with that, let's get going. Many of you may or may not know but there are two major categories of brain injury. One is congenital, and one is acquired. A person who has a congenital brain injury is someone born with it. That's most often the example of someone who has mental retardation. On the other hand, an acquired brain injury which is a very large number of people in this world, is something that happens to somebody's brain after birth. An example might and stroke, a traumatic brain injury, et cetera. And I just wanted to list here for you some the many ways that someone may sustain an acquired brain injury. Today we're going to be just talking about people with traumatic brain injury. But I am here that many of you come in contact with your jobs, with people who may have had strokes, anoxia, neuromuscular disorders, or some other kind of brain injuries. But today we're focusing on traumatic brain injury. So traumatic brain injury for today's discussion as we define it here in Massachusetts and as the Centers For Disease Control as well is be caused by several things. It could be a blunt blow to the head. A penetrating head injury. A crush injury resulting in actual compression of the brain. Or it could be a severe whiplash that causes injury to the brain. An example of blunt injuries, there are things that we're most familiar with people that are injured in motor vehicle-related incidents. Notice I say "incidents." It is politically not correct to call them accidents because there is a strong feeling in the prevention world that every brain injury can be prevented if it's a traumatic brain injury. We deal a lot with people who are injured and hit by cars while riding a bicycle, or individuals who are hit as pedestrians crossing the street. The other type of blunt injury which is becoming much, much more predominant over the years and actually has now exceeded the number of incidents is falls. And falls occur most frequently in the elderly population, and that is now far exceeding the traumatic types of brain injuries. Traumatic brain injury may occur from a gunshot wound to the head or a knife to the head or some other kind of penetration through the skull into the brain. And that is more common, from my perspective, than in urban areas where you see violent crimes and injuries. A crush injury is literally something that can occur in an industrial accident. A perfect example of that is last night I was running a focus group and I met a gentleman injured back in 1987. His injury was a crush injury to the brain. Very significant. He was an auto mechanic working on a car. The car fell down on his head. Very serious injury. It's amazing that the man survived, but that's an example of what a crush injury is. And then finally the whiplash injury which could occur from a number of different things. You may have read about these articles in a newspaper. Someone can literally sustain a traumatic brain injury out of an amusement park on some of those rides where their head is being thrown back and forth. The effect of that for those of how may not be aware of the anatomy of the head and brain is that there is a very, very tiny space between your skull and your brain. And the bones within your skull are very jagged and edges. And if your head is being thrown back and forth which is better known as a coup-contra-coup, then you are causing what you might cause a Bruce that you might see on your hand. It would be bruise to your brain. That can happen with an amusement park ride. It can happen when someone slams on their brakes too quickly and somebody doesn't have a seat belt, or even if they do, their head is thrown back and forth sharply. And more importantly and less known to us is when you shake someone. And this is the Shaken Baby Syndrome which happens to, unfortunately, too many children, babies and young toddlers is not reported as frequently as it should be reported and certainly not identified as frequently as it needs to be identified. So shaking someone is better known as Shaken Baby Syndrom can cause significant brain damage. What's interesting about that and also of course is that when someone's brain is injured to that extent at such a young age, they often grow up with more of a developmental delay, and often at least in our state are served by our mental retardation agency because the injury is so severe, and the developmental delay is so severe. However, that is not always the case. And there are individuals I know that we serve here who have been brain injured through being shaken, the Shaken Baby Syndrom, who are functioning at a much higher cognitive level, and really are much more in the peer group with not mentally retarded but other people with traumatic brain injury. The other incident that I had read and heard about many, many years ago was an adult, which is very unusual, an adult who has sustained a traumatic brain injury. It was actually a soldier who had been tortured in a war and had been shaken as part of that torturing interrogation and had sustained a traumatic brain injury. So there are many ways of sustaining traumatic brain injuries. Now, I'm about to move into the section of this presentation that really speaks to, okay, someone's had a traumatic brain injury. What does that mean? What are the challenges that they may have? What are the skills that they may still maintain? And how is that going to affect them in terms of potential volunteerism within their communities where they live? And what I want to point out before I go to the next slide, and I need for people to understand this, is that an individual with a traumatic brain injury does not usually exhibit all of these challenges or deficits, okay? But they do exhibit multiple deficits from traumatic brain injury. It's very rare that someone with a traumatic brain injury has only a single challenge as a result of that brain injury. And the impairments that result from a traumatic brain injury are dependent upon a couple of factors. One is the type and extent of the brain injury, and that really is how severe, how significant, what part of the brain was injured, to what extent was that injury massive or focussed in one area of the brain? And the other very important thing is the person's pre-injury history. And what I mean by that is the incidents of traumatic brain injury at least from more of the incidents are usually caused and has been caused by individuals who are taking risk by drinking and driving, or drugging and driving. And that often results in a traumatic brain injury. Substance abuse history is a significant factor as an example of someone's pre-injury history and how they're going to function after their injury and what level of impairment they may have sustained. An individual's pre-injury history that relates to other kinds of medical and cognitive issues. For instance, individuals who have attention deficit disorder. Often in children where they're very distracted and they may be stepping out in front of or into the street and get injured in that way, if someone already has a attention deficit disorder, a mind disability of some type, the impact of the brain injury can be much more complex, and much more cumulative in nature. So that's what I mean by pre-injury history when I talk about that here. Okay. What is the impact of traumatic brain injury on someone's cognitive and functioning? What challenges does it affect? And this is what you are most interested in, and I assume what you signed up for. I am going to move through this stuff, but if you have questions don't hesitate to stop me. There are more than several areas of deficits that are potential results of some traumatic brain injury. The first area is called attention inactivity deficit. What it results in is people's distractibility, fatigue and a lack of stamina, potentially slowness of response. Sustaining attention over an extended period of time, and initiation. Now, some examples of how that's going to impact someone's volunteer abilities or considerations that you really do need to look at when you are looking to match someone with a traumatic brain injury in a volunteer slot is these are some of the ways that those kinds of deficits can impact that. You have to look at safety issues. If someone is very distractful due to their traumatic brain injury, you won't put them in a volunteer site that could afford them a real safety issue where they can be distracted or injured, or someone else can be injured. The speed of response is something to consider. I use "motivation" in quotes because when I say "initiation" there are many people with traumatic brain injury that other people work with and they do not realize that someone's initiation problem is a result of their physical injury to the brain. And they then label the person as not being motivated. That happens a lot in the old vocational rehabilitation world. But if you understand brain injury, and you understand that someone's brain injury may have resulted in a lack of initiation, that is not that they're not motivated. It is not an emotional reaction. It is a physiological reaction. And that can be treated with appropriate medications. Some other considerations for attention and activity issues. The ability focus is very important in terms of what kind of volunteer site that you are asking about. And someone's ability to be independent in a volunteer slot. And what you are asking them to do, and are they able to do that. So if there are any other considerations, people feel free to pipe in. But those are some of the things that you want to look at when you are looking to match somebody with a brain injury with a volunteer slot. The next area of potential deficit is communication. And we have issues with verbal expression, reading and spelling potentially, auditory or hearing comprehension, speed of processing, and let me just quickly say that verbal and auditory expression and comprehension issues are often referred to as aphasia. There are two different types of aphasia. There is the aphasia where someone cannot express themselves, and there is the aphasia where someone does not process or understand what you are saying. There are individuals who have had significant traumatic brain injuries who have what's called global aphasia. Global aphasia is the combination of an inability to express yourself verbally and an inability to understand and comprehend. That is a significant challenge for someone with a brain injury to function on a day-to-day basis if they have global aphasia and requires a great deal of technical assistance and support in terms of figuring that out. But in terms of communication deficits, if you are going to be placing someone in a volunteer sites, those are things that you want to think about. Is the person able to follow directions? Can they follow or participate in a conversation? Are they able to listen? Do they understand? Are very important things if you are going to be placing someone out there in a volunteer program. The next area of challenge for people is memory, which is the most common area of challenge for someone with a traumatic brain injury. And so some of the areas that that may affect for individuals are going to be new learning, attention concentration. Again, it's different way from a memory perspective. Short-term memory, and long-term memory. And as you can probably understand, that affect on someone trying to volunteer is that you are going to have to pay attention to that person's ability to learn new expectations. So if you are working with someone already in a volunteer slot or opportunity that they have, and then something changes, their ability to learn those changes may be hampered by their traumatic brain injury, and we need to pay attention to that. The obvious issue of do they remember what they need to do in that volunteer slot that they have? Are they going to remember this task or the activities that they're supposed to be following? Are they going to remember how to get to the volunteer site? That's a very important issue in terms of transportation and access. Will they be able to keep a schedule? Will they be able to remember people's faces and names in those situations? Those are very important situations when you start to talk about someone volunteering. The next area of impairment is something called dysfunction. These are particularly problematic for a lot of individuals who are have had history, someone very accomplished in their professional careers, and their injury occurs later, and they can't go back to what they did before. We deal a lot with people who were CEOs, people that had very high-functioning jobs, and yet their executive functions were such where they could no longer problem solve. They couldn't make good judgments in the moment, and couldn't reason through things that might happen in the moment. They couldn't organize the work activities anymore, their work area. They had no way to prioritize what they needed to do at the beginning of the day to the end of the day. And they had problems executing plans and activities. Obviously some of the challenges that presents is that somebody is going to have a great degree of difficulty in being flexible on the job if they're unable to problem-solve and shift gears at any moment in time. So that's a very important consideration. Any changes in routine. Once again, this can really throw somebody off seriously in being able to accomplish what they need to accomplish, and the side or secondary impact of that frustration often results in other kinds of behavioral problems that we'll talk about in a minute. Finding effective solutions in the moment. Someone with a traumatic brain injury who may have difficulty with that is not the one that you want to place in a volunteer slot or position who is going to have to make decisions and things are going to be changing constantly and they're going to have to make decisions to do something differently, or to approach something differently. And you also don't necessarily want to place someone with a traumatic brain injury in a volunteer job that requires multi-tasking, or doing multiple things at one time if that is an impairment as a result of their injury. The next area which is probably the more obvious area is the physical deficits. But what I need to say is that the world of traumatic brain injury is often referred to, and individuals with traumatic brain injury, are often referred to as individuals, the walking, talking wounded. And the reason that that phraseology is used with individuals with traumatic brain injuries is because even though there are many people who have sustained traumatic brain injuries and have resulting physical impairments there are many more individuals who have sustained a traumatic brain injury and do not show any physical or obvious signs of impairment. This is what's known as one of the greatest hidden disabilities in our community, this along with mental illness. But some of the physical deficits that could result that people experience are motor impairments, sensory and perceptual impairments, visual impairments, ability to articulate, and very complicated medical issues such as seizures, or management of other medications or other things. What is that going to mean to you as somebody working with somebody in setting up a volunteer position? Well, you are going to have to look at someone's mobility capability, and if they have balance or coordination problems. You are going to need to look at their strengths, their physical strengths and abilities. One of the secondary effects is sensitivity to touch, and that's going to be very important and being knowledgeable about that when you are trying to match someone up with a volunteer position. Many have visual impairments. They're not obvious visual impairments, they may not be legally blind or blind, but they may have peripheral vision issues that really affect your ability to carry through on tasks. Seizures are a very common fact after a traumatic brain injury. Many are controlled by medication, but many are not. That's a very important issue as well. Obviously, fatigue on the job, or fatigue in a volunteer site, and what are your expectations of that person and their ability to volunteer for an hour versus a 8-hour day. These are all things that you need to be aware of and think about. The next area of challenge is behavioral, and I just alluded to that before. But I would have to say that in my experience that someone with a traumatic brain injury usually is not successful on a job or in a volunteer site if they cannot perform the actual skills, but because they have other issues such as behavioral issues that interfere and become significant handicaps for their abilities to focus. Some of those are -- some of these behavioral challenges are not recognizing or understanding anymore what the consequences of their behavior are. Being what's disinhibited. People with brain injuries could range from anything from people making specially inappropriate comments to severe sexual disinhibition that places people at risk. You have the issue of impulsivity. The frontal lobe are severely damaged, then people lose their ability to control themselves, if you will take a step back and think about something, but they impulsive respond or react to something. People may have what's called limited insight. Other people call it denial. Once again, this is not so different from what I talked about in terms of initiation versus motivation. Limited insight, or "denial" is physiologically driven in this case. Once again, it's not an emotional issue. It is part of the damage to the brain. So that person really is unable to have the understanding of their own impairments and challenges also requiring a very different approach. This is not someone that is not going to go into psychotherapy with limited insight into the brain injury. They're going to benefit from a cognitive behavioral approach to improving your behaviors or changing their behaviors. Impaired social skills, as I said before, could be sitting and having lunch with other volunteers, and being absolutely inappropriate at the table with those other colleagues. And personality change. People can become what's called very labile. What I mean is that there are moments when people are very cheerful have, no control over it. The next moment laughing their head off. Once again all physiologically driven. If you were somebody working or meeting someone who was a volunteer for the first time and one minute they were crying their eyes out for no apparent reason, and maybe the next minute they were laughing in your face, I think that you would probably have very serious questions and concerns about who this person is, and what's happening. The person's ability to take direction and supervision. If you are trying to train somebody in a volunteer position, and they're not able to follow the directions that you are giving them, and you are trying to redirect them by example, and they perceive that redirection as confrontational, and they impulsively react to you, then you really need to understand and be careful about how you approach them in redirecting them and giving them their directions. As I mentioned already, relationships to other people who they may be around, acting impulsively as I said before. Taking responsibility for their actions, these fluctuating emotions and inappropriate behaviors. All of these are contributing factors to how someone may or may not be successful in a volunteer position. Some other things that you want to keep in mind is understand that our secondary to somebody's traumatic brain injury is that people who have traumatic brain injuries may also have changing interests. And usually it take as extended period of time to work with somebody and to get them settled into one thing. So people with a traumatic brain injury often change job as lot or do a lot of different things after their injury until they settle into something. Medical stability, many medical challenges after their injury may make their availability fluctuate from time to time. That's an important consideration. Transportation. Again, as I said before, many people with traumatic brain injury may not be able to independently maneuver the transportation system. So how do they get to their volunteer site without getting lost? Alcohol and substance abuse as I talked about. Again, level of independence which is an important consideration. And most importantly the stigma of looking okay. The stigma of being the walking, talking wounded in had world. Where someone looks at you and says, "You don't look like you have a disability, so why are you acting that way? Cut to the chase, get off the dime here, and get back to what you should be doing." And then finally people with traumatic brain injury need additional time to be trained in what they're able to do and what they have to do. It takes repetition. Now, where do you begin with someone with a brain injury if you want to do volunteer work this how do you make that successful for them and productive for you? And what key factors are important for to you pay attention to? Those are just two simple things. What does a person need to succeed? What are the obstacles this they might be facing in that volunteer position? Accommodations or alternatives ways to accomplish that. They're a way to bridge between the individual's strength that they have still retained, and the challenges that they have and the challenges that they present in a volunteer opportunity. So it's putting a bridge between those two things. How do you know what kind of accommodations may help and what questions should be asked to try to make the best match between someone with a brain injury and a volunteer slot? Well, you need to know and understand the impact that brain injury has had on that person. And no two people with a brain injury are alike. As I said much earlier, the injury to the brain is varied in terms of how severe it was, where it was, pre-morbid history, all of these things. So it's no easy menu or answer. And, again, as we talked about before, having a brain injury almost always results in a combination of disabilities which may require more than one accommodation. So what are some of the things you may want to do when you are talking with somebody who is interested in volunteering, or maybe somebody who is already volunteering, who has disclosed that they have a traumatic brain injury? Well, some of the things that you could think about asking I've put up here. You should be asking the person what they do well, and what they think their challenges are on a day-to-day basis? What are their perception of that? Ask them if they've used a strategy or device that's worked for them well in the past. Talk to them about their past experiences in volunteering, working, education, whatever, and see how that worked with them and why they moved on from those particular venues. Think about do they need -- and I use the word "job" here in quotes because maybe it's a volunteer coach. And what I mean by that is sometimes people need somebody side by side to kind of keep them directed, get them focussed on their task, get them going, And then that person can stay out. And that may be an accommodation. Try to find out if their home life is stable and if they have a support system. My experience has been that individuals are the least successful in anything that they try to do after their brain injury when they have no support system, or something at home is not going Well. It's very important for to you know that answer if you can find that out. And if you can, and this is absolutely critical, get their permission to speak to someone else who knows them. It could be a parent. It could be a another rehab professional. It could be a teacher. Whatever. And ask those people the same questions that you've just asked that individual. Because one of the problems with brain injury is memory. And people who have brain injuries are not the best for their own histories. So double-check some of that information. Spend some time with them initially to let them use the volunteer stuff around you, and see how they react. Observe their performance. See how they interact with people. Get your own personal sense of that. Try if you can to match what your interest and skills are that they've still retained with challenges, but also with what you need in terms of the right volunteer position and making a match. This is not much different from doing a job match. It's a volunteer match, and it's equally important. Be prepared -- be prepared to offer a lot of support, direction, and structure that you normally would. Compensatory strategies. What are compensatory strategies? Compensatory strategies are accommodations for people with traumatic brain injury. What they are is ways of approaching, and ways of communicating with people, ways of working with people that are nonmechanical in nature that are really helpful with people with brain injuries. So accommodations include not just assistive technologies and devices which we'll talk about, but it includes an approaches, and it's absolutely those approaches for compensatory strategies that are absolutely critical -- absolutely critical to your ability to work with that person. Okay. Here we go. Now, this is something that you may or may not be able to do in the world of volunteerism. I can't tell you that because I am not that familiar with that. So let me tell you this. One of the most important things that can happen for someone after a traumatic brain injury at the right time is to get a comprehensive neuropsychological assessment. That is done by a highly-skilled and trained clinician in the field of neuropsychology, and what they're able to as opposed to other psychologists or a medical doctor is they can explain the impact of the physical injury to the brain to someone's day-today functioning. They can make that connection. They can give you those explanations. They can give those explanations to the individual and their family, and they can make recommendations for ways of approaching that person that would be more successful. So basically that evaluation would include a description, again, of what the person's skills are that still remain. A description of the impairments that are a result of that brain injury, many of which we've talked about. How those impairments impact on their functioning? What recommendations or approaches might be helpful in working with that person. So some approaches that you want to think about, and, again, I will whip through these, and they'll vary -- the one you choose will vary depending on what the person's particular challenges are and needs. First of all, you are going To have to pay attention to their fatigue level, their stamina. You have to consider having a flexible schedule for them because of their availability or ability to get to and from the volunteer site. You have to look at the environmental stimulation and try to reduce distractions. Very importantly -- very importantly are the safety issues that are associated with distractibility. I can't think off the top of my head at a volunteer site that this would be relevant to, but let me give you a work example. If someone was working on a -- in a factory on a line and they were in charge of using the high-level machinery, and they were distractible and looked away and injured themselves on that machinery, that would not be a great job match for them. So there may be volunteer spots that you need to pay attention to them. Speak slowly. Something obviously that I have difficulty doing. But speaking slowly and making sure that someone is understanding, and trying not to interrupt because if you interrupt someone who is talking with you who has a brain injury, it could cause them to lose track of what they were saying and cause them to lose track of their thought process. Ask them to give you feedback to you of what they think they heard you say to ensure that they understood what you said. Okay? And take complex things that they may need to do and try to simplify them into more limited simpler tasks. Consider someone's learning style. A neuropsych evaluation will tell you if someone's learning style is more oriented toward auditory or visual. Then, again, allow additional time to work. Very often we'll communicate visually by role modelling what we expect that person to do is often very valuable, obviously particularly if someone has visual learning skills better than auditory. But it's also a good way for them to see what's expected of them. Write down the instructions. Provide them written instructions. Provide them verbal instructions if they're a auditory learner. Label things. Use color coding. Post notices. Repeat. Repetition is critical. Think about a modification of the physical environment they're working in. If they're doing, let's say, a major mailing for you, or some kind of volunteer activity that has to do with paperwork, you want to reduce the clutter in their area so that they can focus on their task. Think about having checklists that they use every time they come in to volunteer or to work. Think about reminders. Consider volunteer positions where people could possibly pace themselves, and if they have to slow down that wouldn't interfere with them doing the volunteer job. Don't ever make assumptions about someone's ability to do something, or understand something. Always double-check with them. Try to take their work serious. And give to-do lists and other kinds of things. So these are just some of the approaches over the next couple of slides that you will have available to you to think about and to match with your volunteers. So assistive technology. These are mechanical devices that are very helpful. They're helpful to you and me in our daily lives. We always like to say that one of the cheapest ways to access assistive technology is if you give the Lillian Vernon catalogue. Wonderful things in there that we all use. It can be a tool, it can be an alternative way of doing something. Obviously if you have the advantage of an individual getting an assistive technology evaluation, that's wonderful. But if not, some really simple things. Tape recorders for verbal instructions. Alarmed watches or timers to remind someone that now it's time to move on to the next task. A lot of people bring in lots of medication. There are medication dispensers that will beep and talk to people. Electronic organizers. A bulletin board. A walker for people with physical impairments with a brain injury, a walker with wheels on it that has a basket so they can get from one place to another in the volunteer site and bring those things along with them. A daytimer is a wonderful compensatory strategy. It will ask people to track their day and remember where they're going At what time and when. Notebooks, and iPods are a wonderful device for people that are easily distracted and can't pay attention. They have a iPod, they load their music on it, they plug it in, and they sit down and do their volunteer task, and none of the environmental distractions are a problem for them. There are pagers that can be set in such a way that can be reminders. Sticky notes. Walkie-talkies. A digital camera to take pictures of the job responsibilities, or the volunteer responsibility that they have that could be put visually in their work area. Dark glasses if they're visually distracted and sensitive to light. Obvious things for physical impairments for anybody with a physical impairment whether they need a grab bar for stability or handrails. And then identification bracelet. Now that I have whipped through this, and I know I've gone very quickly, there are a number of resources that I want you to have available to you, and these are some of those sites. The first which is the NASHA.ORG site. That's the national association of state head injury administrators. They're an organization that work in state government around the country who have trying to serve people with traumatic brain injuries and their families. They're in all different types of agencies. They're in Voc rehab agencies, in developmental disability agencies, public health agencies, but they're your state government experts within your state. Just about every state has somebody. So if you need to look up what are the state resources that are available to people that you might tap into for your volunteer, or you may recommend to them to go to that website. The next one is the brain injury association of U.S.A. The brain injury association is the organization that represents people with brain injuries and their families. They have state chapters and associations, and they have each state, almost every state once again has a chapter such as that, and you can go there and you can find advocates and support groups and prevention information and referrals to professionals, and just about anything else that you need. And then the final website is the access site. This is just one of many, many sites that you can access for assistive technology. This will give you a link to someone in your state which I thought again was particularly important. So these are just some of the websites that might be useful, and resources that might be useful to you. So with that, let me now with 15 minutes left, let me see if there are any questions from the audience. I will try to field them. I am open to whatever verbally or on the text message. So feel free. >> ELESHEVA SOLOFF: We have 10 minutes left. I need to have the last five minutes with evaluation and a couple of other announcements. Any questions? >> Any questions from anybody? Have I totally overwhelmed you? Okay. Well, it looks like everybody -- oh, I see somebody. Rick. (Cell phone ringing) Oh, you are clapping. Thank you, Rick. I appreciate that. Well, why don't we -- thank you! It's appreciated. I hope that this was helpful to all of you. Please check into those resources. I think that they're very, very valuable. And we will he get you to people within your state who can help you work directly with volunteers, potential volunteers. I think that people with brain injuries have an enormous amount of skills and resources to contribute themselves. It's just really understanding the individual, and matching things carefully. Please make sure that you download a hard copy of this, and I will pass this back on to Elesheva. Thank you all for being patient and listening. >> ELESHEVA SOLOFF: Thank you very much for that informative information. And before anyone signs off, can you please fill out an evaluation? I am going To click on it. I am going To pass it over to Mike who wants to talk about national conference coming up in December. >> Hi, everybody. This is Jason. I am using Elesheva's computer, which is why I am showing up as her. I just wanted to take a brief minute while you are filling out the session evaluation, one, to thank you Deborah so much for taking the time to be with us today. But also to tell you a little bit about a national conference that's coming up. For those of you who may not know, December 8th-10th in Alexandria, Virginia, we're having a national conference on the inclusion for people with disabilities into national service programs. Sorry about that. If you would like information about it, you can get it on the national service inclusion project home page which is serviceandinclusion.org. And what we're going To do is bring together about 500 people over the course of three days to learn and do quite a bit of information sharing, best-practice sharing, things of that nature, all around the inclusion of people with disabilities into specifically AmeriCorps, senior corp, and learning programs. So if that's something that's of interest, please feel free to log on and -- you know, if you can hear me right now, will you just check mark? My yellow light has gone away here. We're connected. >> Jason, I think that we've lost you. >> Jason: I don't know why. I don't know why you seem to have lost me. Is that better? If you can hear me, just send me a check mark. Okay. Sorry about that. I am not sure where you lost me, but long story short, if you are interested, please feel free to log on to serviceandinclusion.org. And you can send an e-mail to the national service inclusion project, and we can send you additional information. With that note, I am going To just say thank you so much and turn it back to Elesheva. >> ELESHEVA SOLOFF: I will have more web teleconferences on the listserv, so keep your eyes open for it I want to thank everyone for coming. Any last-minute questions or comments? Okay. Thank you and have a great day! >> Thank you, everyone for participating. Deborah, that was very good. Thanks! * * * * * This is being provided in a rough-draft format. Communication Access Realtime Translation (CART) is provided in order to facilitate communication accessibility and may not be a totally verbatim record of the proceedings * * * *